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• • <br /> E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> mim WASHINGTON <br /> PROJECT ADDRESS: 1823 STATE ST Permit#: PW2104-015 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: PUBLIC WORKS PERMIT FOR NEW SFR <br /> PW Reviewer to select all that apply below: <br /> Utility Permits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br /> SAP" TARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation&Cost Est.) <br /> r Connection to main plus connections to building 0 New Connection, Size -0 Per Cost Estimate <br /> q .<<eration ❑ Meter Only, Size -❑ Per Cost Estimate <br /> ❑ epair 0 Water System Development Fee Total:$ <br /> ap-off, quantity ❑ ewer System Development Fee Total: $ <br /> econnection to stub ater Service Line(behind meter), Size .3/1/ I' <br /> ❑ Backwater Valve Backflow Prevention (Outside Building):0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED 0 NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size ❑3/" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ Vckflow Prevention(Outside Building): ❑ DCDA <br /> CIckflow Prevention (Outside Building): ❑ DCVA T REQUIRED <br /> E IOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> W TER DEPARTMENT COST ESTIMATE NEEDED-(if yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ es, Quantity See attached for reference. <br /> NOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ ckflow Prevention (Inside Building): El DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> OT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> S_ TpRMW/yrER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> • <br /> ES, WSee Attached for calcul ti s/credit p„ A ' ��4 CI YES,Traffic Mitigation Total:$ <br /> To be added on P © To be added on P U See Attached for calculations/credit <br /> Quantity charged SF Quantity cp arged C�iki► SF OT REQUIRED <br /> QTY is Grand only all hard surfaces QTY is Roof only i all hard surfaces <br /> CI NOV IRED $ 'r . <br /> Additional Checklists: <br /> AD�RESS LETTEI3/REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ES—TY E: SFR ❑ DUPLEX ❑ADU ❑ INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> e Attached Letter,2 copies(Permit Techs to is ue ne copy o appligaot•with permits, scan one copy to Jeffrey Marks) <br /> ital copy attached to permit record, Permit# FWS)li 0I `j <br /> - aved to Address Folder in Development Tech File <br /> ..�I R QUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑yEs—Type <br /> RIOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED <br /> (BYES, Permit#PW <br /> c>Stormwater N DES Tab Completed in TRAKiT in ADA Tab Completed in TRAKiT ❑ Inspections dded in TRAKiT <br /> ❑ NOT REQUIRED <br /> c-5, <br /> Worksheet Completed By: ( Date: <br /> Worksheet Checked By: Date: �(Z- l 2t <br /> REVISED 11/27/2019 <br />